Over-the-counter access to progestin-only oral contraceptives increased contraceptive initiation by 32 percentage points among nonusers and increased switching by 41 percentage points from less-effective methods, with more than half of all OTC purchasers previously relying on no method or less-effective contraception, according to a national cohort study published in JAMA Network Open.
Researchers analyzed data from 986 patients aged 15 to 45 years who obtained oral contraceptives at pharmacies or online between April 2024 and February 2025. Of the total sample, 320 patients obtained oral contraceptives over the counter (OTC) and 666 by prescription.
Patients using OTC access were more likely to be uninsured, live in rural areas, and be adolescents younger than 20 years. They were also more likely to report prior pregnancy and childbirth compared with prescription users. OTC users were less likely to have received contraceptive counseling in the prior year.
Regional differences emerged, with Southern states including Arkansas, Florida, Kentucky, Louisiana, and Oklahoma showing higher OTC use, while western states reported the lowest ratios of OTC use.
Patients cited convenience as the primary reason for selecting OTC access, particularly not needing a medical appointment, not having a regular physician, and efficiency.
Following the Dobbs v Jackson decision, which eliminated federal protections for abortion rights, and with potential reductions in Title X funding under the Trump administration, OTC access may serve as an alternative pathway for contraceptive care.
The OTC progestin-only pill costs approximately $50 for a three-month supply. While cost has historically been a barrier to contraceptive access, six states have passed laws requiring public insurance plans to cover OTC contraception without a prescription, and another seven states use state-only Medicaid funds to provide coverage for Medicaid recipients.
“We found that more than one-half of all those purchasing the OTC OCP for pregnancy prevention were not using a method or were relying on a less-effective method for contraception,” wrote lead study author Maria I. Rodriguez, MD, MPH, of the Center for Reproductive Health Equity at Oregon Health & Science University, and colleagues.
The study concluded that OTC availability of progestin-only oral contraceptives reached patients with greater barriers to care, including uninsured, rural, and adolescent populations. Removing prescription requirements was associated with higher contraceptive initiation and method switching, indicating that OTC access expanded pathways to effective contraception.
The study had limitations, including patients self-selecting between OTC and prescription use and reflecting only early uptake data from the first year of availability.
Full disclosures can be found in the study.
Source: JAMA Network Open